MDAA Service Agreement MDAA Service Agreement NDIS Appeals intake form Name Date Address Please tick each statement to confirm I request MDAA to assist with undertaking an external appeal of a reviewable decision. I understand MDAA will be helping with the external review and aspects related to this process only. I understand if advocacy is required for an unrelated matter, a new request must be submitted. I authorise MDAA to collect information from relevant parties in relation to my appeal. I authorise MDAA to release information to relevant parties in relation to my appeal. I authorise MDAA to refer my appeal to a legal service when legal advice is required as MDAA is not a legal service. I have been provided a Welcome to MDAA Info Book, and the contents have been explained to me by my advocate. I have been informed about the Complaints Resolution and Referral Service (CRRS) a free, independent service funded by the Australian Government (like MDAA) to help people with disability who use Commonwealth-funded disability services resolve complaints. I understand MDAA cannot provide crisis support. MDAA can provide a referral to the right services for me. I understand I have a right to an interpreter. I understand I can arrange a support person for all interactions with MDAA. I understand I can withdraw any authority provided by me above at any time to MDAA (best way to do this is in writing). I authorise MDAA to collect and share my de-identified information with its advocacy funding providers through a data exchange service. Client signature Signature date Clear signature Download PDF